Worried about Endocarditis

[aembry]

I have had many unexplained symptoms over the last month. I did have an echo in early november... Not because of my symptoms, but because of heart palps that I have had for a couple of years. My echo showed mild-moderate tricuspid regurg. Since then I have had a
dental cleaning without antibiotics(wasnt told to take them). Two weeks later my palpitations increased to an almost unbearable amount. I have them pretty much all day. They wake me up a couple times a night and I always have them upon waking. The beginning of december I developed some pain in my legs... Since then I have had daily leg aches(muscles) I have had some joint pains mainly fingers and toes, that are just sharp stabbing pains that are short lived. About two weeks ago I began developing red, tender areas on my toes. 3 on the sides and one on top of my toe below my toenail. I assume these are oslers nodes. I have been a little more tired than usual and have had nausea and just not feeling like myself. The nausea is sometimes relieved just by burping though. I work for a Dr, he listened to my heart thouroghly on thursday and said nothing about a murmur. I had a cbc done on friday but wont be back until in the morning. Will my wbc or anything be abnormal if this is endo?  I am mostly concerned about these areas on my toes, they look like oslers nodes and if they are then this is endo right?

I have also checked my fever several times and it is never elevated. I have though been more cold than normal and very sensitive to cold... Have extreme shakiness and teeth chattering when I go out in the cold.

I am very scared and anxious about this. Am spending all my time trying to figure it out. And these palps... Geez they r driving me nuts. Any advice would really be appreciated.

[Smiley2000]

I have found this article that explains it very well.

http://www.saheart.com.au/for-doctors/guidelines/current-guidelines-for-infective-endocarditis-prophylaxis.html

[skydnsr]

Your points are all good ones.  I don't believe there has ever been any prospective research showing that dental cleaning causes endocarditis or that prophylactic dental antibiotic use, as currently practiced, prevents endocarditis.  From what I understand, the AHA/ACC guidelines are based on "consensus," rather than evidence.  Every time the experts meet to rewrite the guidelines, there will be certain committee members who want to completely do away with antibiotics for teeth cleaning, because there is no evidence that it works.  I think the fear of endocarditis from routine dental cleaning is based more on lore and anecdotal reports, than anything else.  In other words, probably every cardiologist has had somebody who got endocarditis and had had their teeth cleaned not too long beforehand, so there you go.  If you're talking about an abscessed tooth, that's probably a different matter.  But if you can get endocarditis from routine cleaning, then it stands to reason you could get it from flossing or from brushing your teeth a little too hard.  Just my two cents.    

[Occupant]

I have not heard of anybody that takes antibiotics after a tooth cleaning. Do you have extensive bleeding when the dentist does this? As far as Betablockers, I did take them for a number of years and quit them about a year ago. My reasons were shortness of breath especially when exercising and swelling of my ankles. I still have PVC's, but I know what's causing them: NSAID's and Benadryl also Norco.

[ed34]

I get so confused about the dental cleaning thing. I mean, a dental clean by a professional dentist is usually done with suction in the mouth to remove excess fluids while cleaning takes place. Toothpaste contains abrasives such as chalk to grind dirt off the enamel, so surely brushing two or more times a day is going to have the same effect. Why would a dentist be worse? when they get you to rinse several times with an anti-bacterial solution? If the level of bacteria in a persons mouth is really bad (excessive) then just the act of swallowing will pass it into the body because it will get into your saliva and any food/drink consumed. I have had a dental clean every 6 months for 40 years and not once has it been suggested that I take antibiotics. My dentist is aware I have heart issues but laughs if I mention bacteria attacking my valves etc. So just what is the process during a dental clean that causes this issue?

[Smiley2000]

Hi there,

I had SBE (Sub Acute Endocarditis) in 2007.  I can still remember the spiking fevers (chills during the day and night even though it was Summer) and night sweats and muscle aches and eventually the red dots on my hands and legs/feet.  At that stage I had a congenital defect (bad segments on mitral valve) and that is why I got it in the first place.

All bloodtests came back abnormal and VERY high numbers.  I also had an Echo and the Cardio could see vegetations and a T.E.E. was done.

After reading your posts I am sure that you do not have Endocarditis.  I know that it is scary when you first realize that you notice your heartbeats and the missed/skipped/extra beats are no fun to live with.  The Palpitations and PVC's can be brought on by anxiety (adrenalin to the heart) and with an underlying arrhythmia you should increase your potassium levels by adding a banana to your diet.  Even though 3.5 is normal, you should try and get yours to a 4 and you'll see that this would make a remarkable difference on the amount of PVC's you'll get.

20% of the population will have heart valves that will show trivial regurgitation and it is nothing to be alarmed about.  Monitor yourself for signs of heart-failure i.e. swollen ankles, shortness of breath and chest pain on exertion.  

All the best and let us know how you are doing.

[skydnsr]

I was on a beta blocker for about eight years and didn't have any particular side effects from it at first, but eventually I did.  After eight years I got off of it, and I'm doing fine without it now.  I still have PVCs, but they're so mild I don't notice them, and it's not worth taking a medication that I don't like for a symptom that's not really bothering me..  If I were to need the beta blocker again, I'd just have to decide what to do about it at the time.  

Any medication that you try can always be re-evaluated.  If the doctor wants you to take a beta blocker, you can try it and see how you feel about it.  It's not a life sentence.  If you don't like it, you just go back and tell the doc you're having problems with it, and let him give you something else to try.

I re-looked at your B-6 level that you quoted above.  Normal is 20 to 125, and your level is 26, so that's probably why the doctor was not concerned about it, because even though you're at the  bottom of the range, you're still within the range.  I'd probably still take a B-complex supplement for a while, if it were me.  The B vitamins are water-soluble, so any excess washes out of your system.  Sundowner is a cheap one.  They make a B-complex that's fairly low-potency (not their Super B or whatever they call the high-potency one), and it comes in a small pill, which I like.  I've been taking that once a day, just for insurance on the B's.

[aembry]

skydnsr you were correct about the vitamin d, 1000 mg a day. Also told me to take a multivitamin but said nothing about supplementing the b6.  He said that we would recheck my magnesium and potassium in a week?  I am also hooked up to another 24hr monitor :/

Did you have any problems when you were on the beta blockers!? Ive heard really bad things about beta blockers and other meds prescribed for heart rhythm so it kinda freaks me out.

[skydnsr]

I'm guessing the doc will not want to do potassium supplementation, since excess potassium can be dangerous.  You can and should, though, be eating a lot of fresh fruits and vegetables for the potassium.  It's pretty hard to overdose on potassium by eating produce, and you get a lot of other good things when you eat fruits and vegetables.  The vit D, he will probably want to supplement, and the B-6 he will probably want to supplement since he thought it was important enough to order the test.  The magnesium, he probably won't think you need to supplement, but he probably won't object if you want to try taking supplemental magnesium for your palpitations.  That's just an educated guess, and you can tell me later how close I came to predicting right.

I don't know what to make of the tricuspid regurge, either. The tricuspid valve is not a common valve for problems.  What you could do is to get the cardiologist's report for all of the echocardiograms you have had, and read the reports for yourself.  Study them until you understand them, even if you have to go over them word by word with a medical dictionary.  Sometimes what the doctor says on the record is a bit different from what he (or his receptionist) tells you verbally.  The diagnosis or impressions sections and the recommendations sections of the reports are especially meaningful.  

[aembry]

I have heard alot of people say that magnesium helps them, so I will speak with my pcp about that. Also thinking that the pottasium could help as well considering I am on the low end.    

The regurgitation kind of baffles me. When I first started having these there was nothing that could be found causing them. Echo was pretty much great.  The echo I had the first of november the echo tech talked with me the entire time about it( as I do ultrasound myself, Im just not trained in echo and have no idea what regurg looks like) She did tell me I had a little tricuspid regurg but that everyone has some and that I had a very pretty heart. I was not given a follow up appt and the dr never called me with results. Finally after 2 weeks I called the office for results and just got to talk to who Im guessing was just a receptionist.  Was told I had mild-mod regurg and that I did not need to follow up. To follow up with my pcp and get an echo every couple years. So i went from having nothing 2 yrs ago to mild-mod regurg? Whats sad is this cardiologist is suppose to be one of the best in our area, but I felt as if he was very unprofessional. And no one who listens to my heart has heard a murmur, wouldnt their be a murmur with moderate regurg? The whole idea that Im dealing with all these palps and possibly regurg upsets me and really frustrates me. As I am still young and would love to have a family eventually. But, at this point I could never see that happen.

I was also going to mention that when the palps got extremely bad it was around the time of my period the end of last month. My period was over a week late and they have been bad since then. Im a week away from my period again and just hoping they get better with it.  

[skydnsr]

This is one patient to another, but I've had great relief with the pvc's from taking a magnesium supplement.  It wouldn't be a bad idea to check with your cardiologist or PCP to make sure there is no medical problem with doing that, though.  If you choose to try it, I recommend using chelated magnesium, rather than magnesium oxide.  (Magnesium oxide tends to cause loose bowels.)  I use Solgar Chelated Magnesium, which is available on Amazon, if you can't find it locally.  Your doc can prescribe medication to calm the pvc's down, if there is a reason for you not to take a magnesium supplement or if the magnesium doesn't work.  I was on a beta blocker for a long time.

The bigger question is why have your pvc's gotten so much worse lately.  There may be some fundamental cause that needs to be treated, rather than just palliating the pvc's.  I wonder about the tricuspid regurgitation.  My pvc's started when my aortic regurgitation got bad.  Pvc's were the first sign that I had any kind of heart problem, and it does seem that they were secondary to the valve disease.  I've never been told this by a doctor, but my impression is that, because of heart enlargement secondary to valve disease, the heart's electrical conduction pathways got stretched out and distorted, leading to the pvc's.  I never had pvc's until the valve disease had progressed to an advanced state.  

Again, I think you probably have a number of doctors' appointments and tests ahead of you in the next month or two.  And taking again as one patient to another, I'm not hearing anything that I think is going to kill you before you can get through the diagnostic process, or I would tell you to go to the ER and/or do other things to start rattling cages.  Short runs of SVT will not kill you, although, like pvc's, they can be uncomfortable.  

I imagine the doctor is going to put you on a prescription vitamin D supplement for a while; if not, then definitely start taking an OTC supplement for that.  I don't know if the doctor will give you specific instructions about the B6; if not, I would probably just start taking a daily OTC B-complex supplement that includes a good amount of B-6.  Stick with what you have to do to get the diagnostic answers you need, and please continue to let us know how you're doing.  

[aembry]

I know that you didnt mean it that way! I know that I do deal with some anxiety issues though, and that makes me freak out about everything even worse.  I always immediately think I have the worst think I could possibly have. And I do alot of reading & digging and freak myself out even more, hence the myocarditis scare now.

I have actually been diagnosed with pvcs, was diagnosed a couple of years ago when these first started. Ive just never had them to this extent. I have had several an hour, all day long today. And I can wake up at night and literally just roll over and it feels like a fish starts flopping in my chest. The cardiologist I seen in november said I probably have svt.. I have short burst of something and its like 2 really fast beats in a roll. Horrible. And I have been having so many of them lately.

I know some of my symptoms are nonspecific and I guess could be a number of different things. I did get my results of bloodwork on monday. Everything was pretty much  normal except a few borderline things. RBC & WBC were fine. My vitamin d was a few points low and my potassium was right at normal 3.5.  RBC magnesiun was 1.8 with normal being from 1.5-3.1. So I am on the low end of that. Also b6 levels on the low end. 26 with normal being from 20-125.

[skydnsr]

I don't mean to imply that your problem is a mental problem, just that I know there is a lot of (very understandable) mental suffering associated with the concern that you may have a life-threatening illness.  I'm relieved to hear that you have your own doctors.  

The lesions might not be Osler's nodes at all.  What they are needs to be identified, and that is going to take time.  The palpitations may very well be something benign, like PVCs.  If you feel you need to see an arrhythmia specialist, then go for it, but you're still going to need to get established with a "basic" cardiologist who you trust, to follow you for the long term.  

PVCs can be horrible, in terms of the amount of discomfort they sometimes cause; however, they aren't considered to be life-threatening, in and of themselves.  I have been through a period of time when I was having several PVCs per minute, and each one felt like I had a fish flopping around inside my chest.  If it turns out that your palpitations are PVCs, there are ways to deal with PVCs.  If it turns out the palpitations are something else, there will be ways to deal with that, too.  

You've got some things going on with your body that, again, are going to take some time to figure out.  There will be doctors' appointments and tests to go through.  All of that has to be scheduled, one thing at a time.  There's no way to rule out all the possibilities except to go through a step-by-step diagnostic process, but in my non-professional opinion, endocarditis is nowhere near the top of the list.  

Try not to stress yourself unduly.  I know that's easier said than done, but just try to just take one thing at a time and one day at a time.  There's no need to "borrow trouble," as my grandfather used to say, by imagining horrible outcomes that haven't happened yet.  

[aembry]

I do have a cardiologist, but quite honestly I dont trust him. I am currently trying to get in with an arrythmia specialists at a big name hospital to hopefully figure out that problem.

Ill be talking with my pcp tomorrow. I wouldnt even be worried about endocarditist if it wasnt for these places on my toes. If they arent oslers nodes I have no idea what they could be. After thinking about it for awhile, I did have a couple of these come up in the spring on a couple of my toes.  Ive read they occur in lupus sometimes. But the only other symptom I have of that is the muscle aches in my legs. No rashes anywhere.

I do agree that some of it is probably mental. I do have some anxiety issues. But that still doesnt mask the symptoms Im having. After reading more into my symptoms, I now have myself freaked out about myocarditis... Because my palps are so bad! I know both of these things are rare but that still doesnt stop me from worrying.

[skydnsr]

I thought about responding to your post earlier, but I didn't, because there is one big piece of information missing, and it makes a difference.  Do you have a cardiologist?  In fact, do you even have a PCP?  Because having your boss listen to your chest is not going to cut it when you're worried about having endocarditis.  You need to have a cardiologist who you see on a regular basis, even if it's only once a year.  There are blood tests that can be ordered to rule out bacterial endocarditis, but a CBC won't rule it out.  Please see a doctor who is your own doctor -- preferably a cardiologist.  If that has already taken place, feel free to post the details about what happened.  What you are going through is a lot of mental suffering, and I wish you a speedy resolution.  I'm actually doubtful that you have endocarditis.  But what you need is actual medical care.  

[aembry]

Really need some advice!